Unlimited Possibilities

Unlimited Possibilities
Quilted piece I made that is about transformation. I took striped fabrics and cut them into triangles and then made squares.

Sunday, October 17, 2010

Charge Coders Practice Medicine w/o a License

The laws are quite clear on scope of practice. They identify which initials after a name allow the practitioner to do what. Even in nursing there are levels of practice between LVNs and RNs and APNs and NPs. Its all quite confusing. And then there is the ubiquitous tug of war between doctors and nurses. What consumers don't realize is that there is another party practicing medicine, making decisions and they don't have a license. They can also determine what treatment you do or don't get with a computer key stroke. Seems a little like practicing medicine. Lately I've run into a few walls trying to get patients scheduled for needed treatments. When all the dust settled in the bullpen of insurance authorization and we'd wrangled every which way, we realized the snorting bull in all this was coding. There was no code to allow the patient to have all the parts of a medically necessary procedure. Everyone jumped out of the pen and said, "Sorry, we don't have a code for that." Bottom line is that someone creating charge panels didn't understand a complex procedure so they left out part of the procedure and no one was willing to fix it. They did offer an alternative to this missing piece but it costs 15x as much and is more invasive for the patient and it didn't require any authorization.

I'm no expert in the world of insurance authorizations, coding, charging etc. so I might be using incorrect terminology but I do know what its like to be a health care provider on the receiving end of a string of computer code. I'm a nurse wanting her patient to get the right care having to fight the absolute world of coding.

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